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In situations, where a married man harasses his spouse out of irrational jealousy,
and rejects all offers for therapeutic or psychiatric help, the other family members
often turn for help from family physicians and therapists. The article starts with a
short review of the connection between morbid jealousy and domestic violence. It
is suggested that in such situations the practitioner will become the family's
consultant/advocate and offer them principles for optimal coping. These principles
are: realistic expectations, team work, acceptance of feelings and refusal to argue
over facts, non-collaboration with and non-reinforcement of suspicions and lastly,
setting limits and defining consequences.
What do you do when a family seeks help for one member who refuses to
acknowledge that there is a problem, and subsequently refuses all suggestions for
medical or psychological intervention? We are talking about a parent or spouse who
suffers from morbid sexual jealousy. His (and in rare cases, her) symptoms are not
severe and life threatening enough to justify forced hospitalization or summoning the
authorities. And yet we know that escalation is possible and that jealousy is a risk
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factor for domestic violence, in some extreme cases leading to homicide. Following is
an e-mail I have received from a son whose father suffered from morbid jealousy:
I live in a small community in the northern part of the country. During the
last year my father started showing signs of obsessive jealousy towards
my mother. He often goes to her place of work to check whether she is
really there. He also wakes up in the middle of the night and starts
interrogating her and driving her crazy, indicating that she was unfaithful
to him and so forth. He wont leave her alone and this is hurting all of us.
I would like to add that my Dad had a slight CVA [cardiovascular
accident] four years ago, and since then he occasionally sinks into
depression. What are the ways to treat such a problem? I must mention
that my father is a traditional religious person. There are many things in
mental health that he objects to and he is convinced that he is OK. What
should we do?
Not being able to interview and evaluate this individuals state of mind, we
could only assume that he is manifesting morbid jealousy, a term that covers a range
of emotions, irrational thoughts, combined with extreme unacceptable behavior. In
such a state individuals are preoccupied with their partners alleged sexual
unfaithfulness without any actual evidence (Cobb, 1979).
Whereas non-morbid persons might become jealous in response to specificobjective indications and would listen to reason when satisfying explanations are
given, in morbid cases, the belief remains unshaken in the face of contradicting
information, and the list of supposed lovers may keep growing (Vauhkonen, 1968).
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The situation presented here confronts us with serious ethical issues. We must
act with partial information, not based on detailed interviewing; without informed
consent of the identified patient; and on top of that, without any evidence-based
guidelines on therapeutic intervention. Not only that, in light of their professional
socialization, therapists are reluctant to give advice on how to deal with someone who
is not their client. Refusing help is also a decision with ethical implications, as the
situation can deteriorate even further. This might be a good place for readers of this
article to pause and ask themselves how they would have respond to such a request
for help.
As this is a practice oriented article, I will continue with a short literature review
on jealousy and domestic violence and than suggest some priciples for helping
families in such cases.
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distance, scarcity of mental health services in their area, and their lack of experience
with such situations).
The five principles are:
Realistic expectations.
To illustrate these principles, Ill quote relevant sections from my letter to the familys
son:
Realistic expectations: The consultant makes it clear that given the
existing circumstances, the person cannot be helped and that morbidly
suspicious ideation is very resistant to change. We can only aim for
decreased intensity and frequency of suspicious outbursts. Curing the
problem is not our goal, but rather learning to live better with it.
Team work: ...The children and mother and any other involved family
member should meet together to discuss the situation and agree that they
will update each other and coordinate their actions. For this purpose they
will meet together as often as needed. As mother is alone on the battle
field, she must get a lot of support by home visits and frequent phone
calls.
Empathy: Regarding your Dad, you can all agree with his feelings, never
with the facts as he sees them: You must be sufferingIt must be awful
after all these years not being able to trust your wifeI respect your
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feelingswe can not argue with them The only facts are that you
suffer and you make mother suffer too. Your feelings are your business;
we will understand if you do not want to stay in such a marriage and will
help you separate if you so wish, but when you make Mom miserable, that
becomes our business.
Non-collaboration: Mother needs instruction on how to answer Dad.
This necessitates rehearsals and role-playing. One of the siblings can play
Father, letting Mother experiment with different responses. She should
never answer questions of fact (whether she has a lover, or met someone).
Giving answers to a suspicious person, and especially when it seems
reassuring and calming, just reinforces his tendency to ask again and
again. Instead, your mother should talk about her own feelings: your
suspicions hurt and insult meit is terrible to live with someone who
cant trust me. When you talk like this, I feel that I live with a
strangerThe more you behave like that the more it gets difficult to love
and respect you."
Setting limits: All of you must decide on rules of accepted behaviors, and
make the rules and the consequences of their infringement clear to your
dad. For example: It is forbidden to wake your mom at night or go to her
place of work. You have to decide what would happen if your dad does it
anyway. These messages have to be transmitted with a combination of
respect and firmness, with expressions of love to both your parents.
Possible results could be to have one of the children stay a night with the
parents or have Mom move in with you for a day or two. All sanctions
should be time limited and delineated in advance. It should be made clear
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that in cases of physical abuse or threat you will involve the police
immediately. Dad should understand that this is not just the couples
issue, but rather a family one. Alone mother could be conceived as weak.
Dad will hesitate however to confront a united family.
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In concluding such a presentation, it would have been expected to
suggest that controlled studies of the problem are needed. Unfortunately, due to
lack of cooperation of the identified patients, this is not applicable. It would be
beneficial to have other publications on practitioners experiences in dealing
with the dilemma.
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References
Block, C. R. & Christakos, A. (1995). Intimate partner homicide in Chicago over 29
years. Crime and Delinquency, 41, 496-526.
Cobb, J. (1979). Morbid jealousy. British Journal of Hospital Medicine, 21, 511518
Dell, S. (1984) Murder into Manslaughter. Oxford: Oxford University Press.
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Mullen, P. E. & Maack, L. H. (1985). Jealousy, pathological jealousy and
aggression. In D. P. Farrington & J. Gunn (Eds.), Aggression and
Dangerousness, pp. 103126. London: Wiley.
Silva, J. A., Ferrari, M. M., Leong, G. B., et al (1998). The dangerousness of
persons with delusional jealousy. Journal of the American Academy of
Psychiatry and the Law, 26, 607623.
Stearns, Peter N. (1989). Jealousy: The evolution of an emotion in American history.
New York: New York University Press.
Stets, J. E., & Pirog-Good M. A. (1987). Violence in dating relationships, Social
Psychology Quarterly 50, 237-246
Vauhkonen, K. (1968). On the pathogenesis of morbid jealousy. Acta
Psychiatrica Scandinavica Supplementum, 202, 2261.
Wallace, Harvey (2004). Family violence: Legal, medical, and social perspectives.
Boston: Allyn & Bacon.